The impact of social networks on hepatitis C transmission and care access in people who inject drugs

社交网络对注射吸毒者丙型肝炎传播和护理获取的影响

基本信息

批准号：
9201523
负责人：
Oluwaseun Falade-Nwulia
金额：
$ 18.37万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-15 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9201523
关键词：
Acquired Immunodeficiency Syndrome Adverse effects Antiviral Therapy Appointment Award Baltimore Behavior Therapy Caring Cessation of life Characteristics Clinical Clinical Investigator Clinical Trials Communicable Diseases Communities Data Development Development Plans Disease Progression Drug usage Drug user Epidemic Epidemiology Equipment and supply inventories Funding Goals Grant HIV HIV Infections HIV/HCV Health Health Services Accessibility Healthcare Hepatitis C Hepatitis C Prevalence Hepatitis C Transmission Hepatitis C co-infection Hepatitis C virus Indiana Individual Infection Information Networks Injecting drug user Intervention Intravenous Knowledge Link Liver Cirrhosis Liver diseases Malignant neoplasm of liver Medical Medicine Methods Molecular National Institute of Drug Abuse Opioid Oral Outcome Participant Pathway interactions Pattern Pharmaceutical Preparations Phylogenetic Analysis Physicians Population Prevention Public Health Quality of life Recruitment Activity Reporting Research Infrastructure Research Training Resources Role Sampling Social Network Specialist Sustainable Development Technical Expertise Testing Time Training Treatment outcome Universities base career career development cohort effective therapy experience improved indexing injection drug use inner city innovation laboratory experience member mortality patient oriented prevent seroconversion skills social tool transmission process treatment duration

项目摘要

PROJECT ABSTRACT Hepatitis C is a major public health challenge particularly among HIV infected people who inject drugs (PWID). Despite recent availability of new oral, efficacious HCV therapies of short duration with minimal side effects, rates of HCV treatment in PWID remain low. Accelerated rates of liver disease progression in HIV/HCV co- infected individuals make HCV treatment among HIV infected PWID a priority. PWID social networks have the potential to serve as vehicles to increase rates of HCV treatment and prevent HCV reinfection. There is however little know about PWID social networks as it relates to HCV infection, care access and transmission patterns in inner city US populations. The goal of this project is to fill these knowledge gaps as a bridge to developing effective combined biomedical and behavioral (bio-behavioral) interventions to improve HCV treatment and prevent HCV reinfection among HIV infected PWID. I am an infectious disease trained physician with training in epidemiology, prior laboratory experience in molecular methods and practical clinical experience providing HIV and HCV care to inner-city HIV infected PWID. My long term goal is to conduct sophisticated clinical trials of combined biomedical and behavioral interventions to improve HCV/HIV medical care, treatment and prevention as well as understand transmission dynamics to prevent HCV reinfection. The proposed studies are nested in two NIDA funded PWID cohorts, the prevention and testing (Lighthouse) study and the AIDS Linked to the IntraVenous Experience (ALIVE) cohort, both representing HIV infected and uninfected inner-city Baltimore PWID. Aim 1 utilizes data from social networks of index HIV-infected PWID to determine if HCV clusters within PWID social networks. Aim 2 will assess individual- and network-level barriers and facilitators of HCV care among HIV infected PWID in the oral DAA era. Aim 3 will assess if social networks document HCV transmission through use of complementary social network and phylogenetic analyses. The proposed career development plan will expand my technical skills through additional expertise in: (1) social network analyses; (2) recruitment of PWID social networks and assessment of social determinants of PWID HCV/HIV related health outcomes; 3) phylogenetic analyses and 4) implementation of bio-behavioral interventions. I will be well supported within the Department of Medicine at Johns Hopkins University and will benefit from the excellent research infrastructure of the Lighthouse and ALIVE studies at Johns Hopkins. With the recent national epidemic of transition from oral opioid to injection drug use and attendant increase in HIV and HCV infection rates, development of sustainable interventions to increase rates of HCV treatment among PWID and reduce rates of HIV/HCV infection have become a priority. This award will facilitate my pathway to an independent career as a patient-oriented clinical investigator committed to developing interventions to increase rates of HCV treatment and prevent HCV reinfection among HIV infected PWID.

项目摘要丙型肝炎是一项重大的公共卫生挑战，特别是对于注射吸毒者 (PWID) 的艾滋病毒感染者而言。尽管最近出现了新的口服、有效、短期且副作用最小的 HCV 疗法，注射吸毒者的丙肝治疗率仍然很低。 HIV/HCV 合并患者肝病进展速度加快感染者将 HIV 感染吸毒者中的 HCV 治疗作为优先事项。 PWID 社交网络有具有作为提高 HCV 治疗率和预防 HCV 再感染的工具的潜力。有然而，人们对吸毒者社交网络知之甚少，因为它与丙型肝炎病毒感染、护理获取和传播有关美国内城人口的模式。该项目的目标是填补这些知识空白，作为桥梁开发有效的生物医学和行为（生物行为）组合干预措施以改善丙型肝炎病毒治疗并预防感染艾滋病毒的吸毒者中丙型肝炎病毒的再感染。我是一名接受过传染病培训的医生，接受过流行病学培训，拥有以下方面的实验室经验：为内城区艾滋病毒感染者提供艾滋病毒和丙型肝炎护理的分子方法和实际临床经验注射吸毒者。我的长期目标是进行生物医学和行为相结合的复杂临床试验改善 HCV/HIV 医疗保健、治疗和预防以及了解传播情况的干预措施动态预防HCV再感染。拟议的研究嵌套在两个 NIDA 资助的吸毒者队列中，即预防和测试 (Lighthouse) 研究和 AIDS Linked to IntraVenous Experience (ALIVE) 队列，均代表 HIV 感染者和巴尔的摩市中心未受感染的吸毒者。目标 1 利用来自 HIV 感染者社交网络的数据来确定 HCV 是否在吸毒者社交网络中聚集。目标 2 将评估个人和网络层面的障碍以及口服 DAA 时代 HIV 感染者中 HCV 护理的促进者。目标 3 将评估社交网络是否通过使用互补的社交网络和系统发育分析来记录 HCV 传播。拟议的职业发展计划将通过以下方面的额外专业知识来扩展我的技术技能：(1) 社交网络分析； (2) 吸毒者社交网络的招募和吸毒者社会决定因素的评估吸毒者丙型肝炎病毒/艾滋病毒相关的健康结果； 3）系统发育分析和4）生物行为的实施干预措施。我将在约翰·霍普金斯大学医学系得到大力支持，并将受益于约翰·霍普金斯大学 Lighthouse 和 ALIVE 研究的卓越研究基础设施。随着最近全国流行从口服阿片类药物转向注射药物使用以及随之而来的增加 HIV 和 HCV 感染率，制定可持续干预措施以提高 HCV 治疗率减少注射吸毒者的艾滋病毒/丙型肝炎病毒感染率已成为当务之急。这个奖项将有利于我作为一名以患者为导向的临床研究者，致力于开发独立的职业生涯提高 HCV 治疗率并防止 HIV 感染吸毒者中 HCV 再感染的干预措施。